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Predicting cognitive decline using neuropsychiatric symptoms in prodromal Lewy body dementia: A longitudinal study

Wright, Laura M.; Donaghy, Paul C.; Burn, David J.; Taylor, John Paul; O'Brien, John T.; Yarnall, Alison J.; Matthews, Fiona E.; Firbank, Michael J.; Thomas, Alan J.; Lawson, Rachael A.


Laura M. Wright

Paul C. Donaghy

David J. Burn

John Paul Taylor

John T. O'Brien

Alison J. Yarnall

Michael J. Firbank

Alan J. Thomas

Rachael A. Lawson


Introduction: Neuropsychiatric symptoms (NPS) in Lewy body dementias (LBD) occur frequently and early in disease progression. Such symptoms are associated with worse quality of life, caregiver burden and functional limitations. Limited evidence exists, however, outlining the longitudinal relationship between NPS and cognitive decline in prodromal LBD. Methods: 123 participants were derived from three cohort studies. Patients with mild cognitive impairment (MCI) relating to probable dementia with Lewy bodies (MCI-LB, n = 67) and Parkinson's disease (PD-MCI, n = 56) completed comprehensive cognitive and neuropsychiatric assessment and were followed up longitudinally. Linear regression and mixed effects models assessed the relationship between baseline NPS and cognition at baseline and over time. Results: In MCI-LB, overall NPS burden was associated with declines over time in executive function (p = 0.026) and processing speed (p = 0.028) and baseline aberrant motor behaviour was associated with declines in attention (p < 0.025). Anxiety was significantly associated with poorer visuospatial functioning (p = 0.016) at baseline and poorer attention both at baseline (p = 0.017) and across time points (p = 0.024). In PD-MCI, psychosis was associated with poorer executive functioning at baseline (p = 0.008) and across time points (p = 0.002) but had no association with changes longitudinally. Conclusions: Core neuropsychiatric components of LBD are not strongly associated with cognition in prodromal disease. This may suggest that neuropathological mechanisms underlying NPS may not be the same as those underlying cognitive impairment. Non-core NPS, however, may be more directly associated with cognitive change. Future studies utilising neuroimaging techniques are needed to explore the neuropathological basis of NPS in prodromal LBD.


Wright, L. M., Donaghy, P. C., Burn, D. J., Taylor, J. P., O'Brien, J. T., Yarnall, A. J., …Lawson, R. A. (2023). Predicting cognitive decline using neuropsychiatric symptoms in prodromal Lewy body dementia: A longitudinal study. Parkinsonism and Related Disorders, 113, Article 105762.

Journal Article Type Article
Acceptance Date Jul 7, 2023
Online Publication Date Jul 8, 2023
Publication Date Aug 1, 2023
Deposit Date Jan 21, 2024
Publicly Available Date Jan 25, 2024
Journal Parkinsonism and Related Disorders
Print ISSN 1353-8020
Electronic ISSN 1873-5126
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 113
Article Number 105762
Keywords Lewy body; Parkinson's disease; Dementia; Neuropsychiatry; Cognition
Public URL


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